Hwang Deokbi, Kim Hyung-Kee
Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Vasc Specialist Int. 2021 Dec 29;37:40. doi: 10.5758/vsi.210056.
Diabetes and renal failure frequently involved in small vessel arteriopathy. With medical advancements, those patients survive longer with an increasing incidence of resultant arterial occlusive disease affecting the distal upper extremity (UE). In patients with ulcers or gangrene in the distal UE, bypass surgery is often complicated by severe atherosclerosis with calcification, resulting in poor distal anastomosis quality. Here we report a patient with a fingertip gangrene who were successfully treated with in situ bypass from the brachial artery below the elbow to the radial artery in the anatomical snuffbox under local anesthesia. Bypass graft patency was maintained during the 18-month follow-up. If the forearm cephalic vein and radial artery in the anatomical snuffbox are of adequate quality, in situ bypass to radial artery in the anatomical snuffbox may be a useful option for limb salvage in selected patients.
糖尿病和肾衰竭常伴有小血管动脉病变。随着医学的进步，这些患者存活时间更长，导致影响上肢远端（UE）的动脉闭塞性疾病的发病率不断上升。在患有上肢远端溃疡或坏疽的患者中，旁路手术常因严重的动脉粥样硬化伴钙化而复杂化，导致远端吻合质量差。在此，我们报告一例指尖坏疽患者，在局部麻醉下成功进行了从肘部以下肱动脉到鼻烟壶部桡动脉的原位旁路手术。在18个月的随访期间，旁路移植血管保持通畅。如果前臂头静脉和鼻烟壶部桡动脉质量足够，对选定患者进行鼻烟壶部桡动脉原位旁路手术可能是挽救肢体的有用选择。
